South Africa’s government has pledged to keep its world-leading HIV program alive despite the withdrawal of $427 million in U.S. support. But the funding gap is proving difficult to bridge, and health experts warn that the coming years could see a surge in new infections and preventable deaths.
With more people living with HIV than any other country, South Africa has long relied on foreign aid to sustain its treatment infrastructure. The abrupt cuts initiated under former U.S. President Donald Trump led to the closure of 12 nonprofit clinics, leaving over 63,000 patients without regular care and disrupting medication access for up to 220,000 people.
For many, the consequences have been devastating. A sex worker who asked to remain anonymous described how the now-defunct clinic had provided vital services directly to her home: quarterly testing, medication refills, and access to condoms and lubricants. “Our lives matter, we are human,” she said, reflecting the deep sense of abandonment felt by vulnerable communities.
Despite government assurances, patients report being turned away from public hospitals. Others have resorted to the black market, where the cost of HIV medication has nearly doubled raising concerns about safety and affordability.
Yvette Raphael, co-founder of the Advocacy for Prevention of HIV and AIDS group, voiced fears of a reversal in progress. “We are scared,” she said. “Scared of rising infections, scared of people dying again, scared for the infants who may be born with HIV due to lack of services. The U.S. funding filled a gap our government couldn’t.”
Even before the aid cuts, only 2 million of South Africa’s estimated 8 million HIV-positive individuals were receiving treatment. The sudden loss of support has exposed the fragility of the system and amplified the urgency for sustainable solutions.
The impact of U.S. aid reductions has rippled across Africa, the continent most affected by the cuts. Defending the decision, U.S. officials cited national debt concerns and called for African nations to take on more responsibility for healthcare provision. “At some point, the continent of Africa needs to absorb more of the burden,” said Russell Vought, former director of the U.S. Office of Management and Budget.
Some South Africans speculate whether the policy shift was influenced by Elon Musk, a native of the country, who reportedly supported early efforts to reduce U.S. foreign aid. One transgender woman, now forced to pay privately for preventive medication, expressed her anger: “I’ve got no civil words to express how I feel, but I just hate them for what they did. Our lives matter.”
Although the U.S. has since issued a limited waiver allowing some critical HIV services to resume, the damage is already done. For many, the loss of consistent care has created chaos and the road to recovery remains uncertain.
